Erectile Dysfunction from Prostate Cancer Treatment | Prostate Cancer Staging Guide





PCRI’s Executive Director, Mark Scholz, MD, talks about erectile dysfunction that occurs after prostate cancer treatment. He covers the risk of side effects and practical information about how to weigh the risks and benefits of treatment.

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0:26 Each treatment has a different risk of impotence. Focal treatment tends to have the least erectile side effects, radiation having an intermediate risk of side effects, and radical prostatectomy having the highest risk of impotence after treatment

1:03 The onset of erectile dysfunction varies by treatment. Radical prostatectomy causes immediate erectile dysfunction. Men typically recover over a period of time. Radiation on the other hand typically does not have an immediate effect on erectile function, but rather, erectile function after radiation will tend to worsen as time goes on. This distinction is important because the immediate erectile dysfunction after surgery can cause atrophy and scarring of the penis from a lack of use.

2:10 Erectile dysfunction can have serious psychological side effects on men. When erectile dysfunction occurs, men can lose interest in pursuing intercourse, which in turn can worsen the problem. This reality must be taken into consideration as treatment is being selected. Men still have sensation even if the erectile function is reduced. But sexual activity after treatment is different. Additionally, after any form of prostate treatment, men will have dry orgasms, which will also change the sensation of sexual activity. Many men are not informed of this fact.

4:05 Practitioners often cite favorable statistics when trying to convince men to choose one treatment over another. The reality is that most of these statistics have a different definition than one might expect. Most studies that are quoted define impotence as the inability to get an erection even when taking a drug like Viagra, also they define potency as the ability to get a “serviceable erection.” So erectile function and people’s daily lives are affected more than what the quoted statistics might suggest. You may not be told in your consultation that you will have to take Viagra-like drugs and that the quality of your erections will be reduced.

5:50 Age has a notable effect on erectile function after prostate cancer treatment. Men who are younger tend to recover better. But as men get older, they are more likely to experience worse side effects. Also, men with preexisting erectile issues will likely have much worse outcomes depending on the treatment selected.

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